Objective: Objective: To identify pulse-width (PW) optima for motor performance using quantitative video kinematics in patients with Parkinson’s disease (PD) undergoing subthalamic nucleus deep brain stimulation (DBS).

Background: Background: PW is a routinely adjustable DBS programming parameter, but clinical guidance for its optimization remains largely empirical. Quantitative kinematic assessment during standardized motor tasks offers an objective, high-resolution window into stimulation-dependent motor changes that coarse clinical ratings may miss.

Method: Methods: Hand movement (HM) kinematics were recorded across multiple PW settings (10,20,30,40,50,60,90 µs) during bilateral DBS programming sessions (94 observations, 20 hand units, 10 patients). Motor features were grouped into four clinically meaningful domains: Vigor, Timing, Variability, and Decay. Pooled quadratic mixed-effects models estimated population-level dose-response curves and PW optima per domain. A domain-level principal component analysis (PCA) further summarized overall motor response.

Results: Results: Movement vigor and variability showed clear inverted dose-response relationships with PW, with significant quadratic effects (p=6.6e-06 and p=6.4e-08 respectively) and population-level optima consistently clustering between 47–53 µs (nearest standard setting: 50 µs). The overall kinematic composite (DomainPC1) mirrored this pattern strongly (quadratic p=7.1e-08). Movement decay improved linearly with lower PW (p=2.7e-04). Person-level optimum estimates were less stable, reflecting the need for larger datasets to support individualized programming guidance.

Conclusion: Conclusions: Quantitative hand movement kinematics identify a consistent population-level motor optimum near 50 µs in subthalamic DBS. This optimum falls below the conventionally used 60 µs setting, suggesting that lower PW values may merit prospective evaluation in motor programming. These findings support the clinical utility of kinematic monitoring during PW optimization, though larger datasets are needed before individualized programming recommendations can be made.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pulse-width-dependent-motor-performance-in-deep-brain-stimulation-of-subthalamic-nucleus-in-parkinsons-disease-evidence-for-a-kinematic-optimum-near-50-%c2%b5s-in-hand-movement/